European Journal of Molecular & Clinical Medicine

Introduction:  Cerebrovascular accident (CVA) or stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Cerebrovascular accidents (CVA) can be classified into two major categories: about 87% of strokes are ischemic, the rest being haemorrhagic.Studies have demonstrated the fact that primary neurologic abnormalities may produce ECG changes without any myocardial lesion.
Aim: To study the various types of ECG changes in patients of cerebrovascular accidents. To compare the ECG changes in patients of haemorrhagic and ischemic cerebrovascular accidents.
Material and methods: This present study was carried out in 50 cases diagnosed as CVA admitted in the Department of Medicine in a tertiary care hospital of Punjab(North India) after obtaining their informed consent.All patients with CVA of less than 10 days duration admitted in the Department of Medicine were included in this study. A detailed history was taken and patients were selected as per inclusion and exclusion criteria. Along with other investigations 12 lead ECG tracing on admission and after 72 hours of stroke onset was performed. The ECGs were analysed for the occurrence of arrhythmias, ST-T segment changes, changes in various intervals and ectopic beats.
Results: In our study population of 50 patients, 38 (76%) patients were having ischemic stroke and 12 (24%) patients were having haemorrhagic stroke. In our study, prolonged QTc was the most common ECG abnormality.In our study, ST segment changes were most commonly noted in ischemic stroke.12% of patients with ischemic stroke had ST depression and 2% had ST elevation. In our study, sinus tachycardia was the most common rhythm change observed in both ischemic CVA(26%) and haemorrhagic CVA(36%) followed by sinus bradycardia.
Conclusion: This study showed male predominance in stroke cases. Cerebral infarction was more than haemorrhage.ECG changes were more commonly associated with ischemic stroke as compared to haemorrhagic stroke.Cardiac disturbances are diverse and frequent in the setting of acute neurological injury.Understanding of these ECG changes occurring in patients with CVA is important because it may lead to erroneous judgment of assigning these patients as CAD.These patient should be evaluated for cardiac injury and treated only if necessary.

Alcohol is most commonly abused drug worldwide. Alcohol use has also been shown
to have numerous effects on the cardiovascular system other than heart failure.It has
been associated with arrhythmia(eg.atrial fibrillation ,ectopics),hypertension and
sudden death [1] .
METHODS:
This is a hospital based cross-sectional study carried out in 100 chronic alcoholics
admiited at Dr.PSIMS&RF, Chinnoutapalli ,tertiary care, teaching hospital in South India for a period of 2 years.Their cardiovascular function is evaluated by
Electrocardiogram and Echocardiogram.
RESULTS:
Out of 100 patients, In the study group 94% were males and 6% were
females.Maximum incidence of Alcoholics was seen between 3 rd to 6 th Decade of
life.Mean age was 43.1 ±11.9 years .
Most common abnormality observed was sinus tachycardia(10%) followed by
Qt prolongation (7%),LVH and AF(5%),VPC(4%),NSC and RBBB(3%),APC(2%).
Most common echo abnormality was Increased LAD size(14%),increased
RVSP (12%),Increased thickness in IVS and Posterior wall(11%),EDD,EDS,EF,FS
abnormality was observed in 10% patients. Other findings like MR,TR,PAH seen in
1%,TR,PAH in 5%,MR IN 4 % population,remaining 90 % are normal. In Echo final
impression of LVH Seen in 11% and DCM was seen in 10%Population. Prevalance of
cardiovascular abnormalities In patients with chronic alcoholism was ECG 39 %
ECH0 21%
CONCLUSIONS: Early screening by means of ECHO and ECG can be useful in
preventing the progression to irreversible changes.Alcohol de-addiction and
counseling should be encouraged

Background: Prediabetes is a disorder of glucose homeostasis characterized by impaired glucose tolerance or impaired fasting glucose. Prediabetes is associated with structural RA and RV changes, and impaired RV systolic and diastolic function, independent of cardiovascular risk factors. Prediabetics are at increased risk of developing type 2 DM. Present study was aimed to assess cardiovascular morbidities in prediabetic individuals.
Material & Method: This hospital based analytical comparative study was conducted among the individuals attending the medicine OPD of Aarupadai Veedu Medical College & Hospital aged more than 18 yrs with impaired fasting glucose and healthy controls. Comparison between Venous Blood Glucose Levels(Fasting, Impaired Glucose Tolerance) and changes in Electrocardiography, Echocardiography were done.Patients with pre-diagnosed cardiac disease, pancreatic disease, chronic kidney disease, thyroid disorders, dyslipidaemia, obese persons and pregnant women were excluded from the study. All the collected data were analysed using SPSS v21 operating on windows 10, with p<0.05 considered statistically significant.
Results: Total 252 participants included among them assessment of the cardiovascular morbidities were done, There were significant higher incidence of ECG and 2D ECHO changes among prediabetic compared to the controls. The ECG  and 2D ECHO abnormal findings were seen in 71.5% among the prediabetic cases and zero % in controls.(p<0.05). Mean weight of cases was significantly higher than  controls, BMI was significantly higher in cases compared to controls. (p<0.05)
Conclusion: Present study concludes that there is higher incidence of cardiovascular morbidities among the Prediabetes individuals compared with normoglycemic healthy individuals.

In medical practise, an electrocardiogram (ECG) is a crucial indicator tool for assessing cardiovascular arrhythmias. In this study, a machine learning system is used to compare patient ECGs and perform programmed ECG arrhythmia identification. The system was previously tuned based on an overall image informational index. Arrhythmias are more prevalent in those over the age of 60. A convolutional neural network (particularly, Alex Net) is utilised to extract features, and the highlights are then passed via a basic back spread neural network to finish the classification. The fundamental purpose of this research is to provide a simple, effective, and relevant learning strategy for categorising the three types of heart conditions (cardiac defects) so that a diagnosis may be made. The findings showed that when a moving deep learning highlight extractor was combined with a standard back proliferation neural architecture, very elite rates could be achieved. In a comparative analysis, validation accuracy was shown to be 100 percent in Google Net, 94 percent in Squeeze Net, and about 97.33 percent in Alex Net.

Background: To evaluate the serum ferritin levels in patients with acute myocardial infarction. To inspect normal healthy individuals with non-cardiac chest pain for serum ferritin levels. To distinguish ferritin levels persisting in both the study population. Comparing serum ferritin levels to the probability of developing acute myocardial infarction. To study relevance of serum ferritin level to acute myocardial infarction.
Material and Methods: A case controlled study was held by Department of General Medicine, Government General Hospital, Suryapet, Telangana, India from December 2021 to September 2022. The study consisted of male patients with myocardial infarction for determining the association of serum ferritin to acute myocardial infarction.
Results: The statistical analysis data for the evaluation of study details for different diagnostic test between cases and control group and determines significance between them. Comorbidities associated with cases and control shows that evidence of diabetes mellitus. The comparison of ferritin and lipid profile no significance existed. On differentiating ferritin administrated value to that of day 3 shows statistical significance. While comparing ferritin and glycaemic control, correlation prevailed. A mixed results were obtained from performed study that proved insufficient to correlated ferritin with myocardial infarction.
Conclusion: The study contradicted the hypothesis. Neither of the tested iron biomarkers confirmed the iron hypothesis, based on the meta-analysis. These finding suggest that the evidence is not robust enough to support the connection among iron and cardiovascular disease. This discrepancy in results could be due to the study's use of different iron markers. Despite the large amount of data that has been published to far, the importance of iron in CVD is still up for debate.

Background: In the industrialized world, stroke has acquired third place as an important cause of death. It has been estimated that annually >50 lakh people die due to stroke. But most of these second attacks can be seen within one year of first attack of stroke. Aims: To find out occurrence and pattern of electrocardiographic and 2D Echocardiographic changes in newly diagnosed acute stroke subjects Study Design: A Cross-Sectional Observational study. Place and Duration of Study: Study was conducted at Department of general medicine, Dr D Y Patil Medical College, Pune, October 2020-september 2022. Methodology: This study conducted in a semi-urban Teaching Hospital in Maharashtra, India. Data analysis was done using SPSS (Statistical Package for Social Sciences) Software version 20.

Background: Dengue is a febrile illness caused by infection with 1 of 4 dengue viruses transmitted by the Aedes mosquito. The present study was conducted to assess ECG manifestation of dengue fever.
Materials & Methods: 82 dengue fever patients were enrolled in study. Clinical features and ECG changes such as sinus bradycardia, sinus tachycardia, non- specific ST changes and RBBB were recorded.
Results: Out of 82 patients, males were 50 and females were 32. We observed that common clinical features were fever in 75, myalgia in 23, headache in 41, abdominal pain in 32, rashes in 15, arthritis in 17, palpitations in 20 and diarrhoea in 5 cases. We found that common ECG changes were sinus tachycardia in 6, sinus bradycardia in 30, non- specific ST changes in 12 and RBBB in 4 cases. The difference was significant (P< 0.05).
Conclusion: Common ECG abnormality in patients with dengue fever was sinus bradycardia.

Background:To study the prevalence of Pulmonary Hypertension (PH) in patients with Chronic Kidney Disease (CKD).
Materials and Methods: The present study assessed the prevalence of PH in 50 patients with CKD, at DR.PSIMS & RF, Chinnavutpalli, Gannavaram.
Results: The commonly affected age group in study population was 31-50 years. The mean age of patients was 48.98±12.53years. Diabetes Mellitus was present in 15 (30%) and Hypertension in 48 (96%).  Majority of the patients were in CKD stage 5, i.e.,46 (92%), CKD stage 4 -3 (6%), CKD stage 3- 1(2%). The prevalence of PH in CKD is 22 (44%). PH was not found in the patient with CKD stage 3. PH was found in 2 of the 3(66.6%) patients with CKD stage 4. Out of the 46 CKD stage 5 patients, 20 (43.4%) had PH. With reference to the severity of PH with CKD, the two patients of PH  CKD stage 4 had moderate PH . Out of the 20 patients of PH with CKD stage 5, 10 patients had mild PH, 9 with moderate PH and 1 with severe PHOn Chest X ray, descending right pulmonary artery dilatation and cardiomegaly were seen in more number of patients with PH, compared to those without PH. (p<0.001). In this study, LV systolic dysfunction was present in 18 out of 50 patients (36%). Among 22 patients with PH, it was present in 13 (59.09%). Among 28 patients without PH, it was present in 5 (17.85%). LV systolic dysfunction was significantly higher among the patients with PH compared to those without PH. The mean EF of all patients with CKD is 55.62± 9.54. The mean EF of patients with PH and without PH in the study was 50.50±9.78% and 59.64±7.26% respectively. (p<0.02). LV diastolic dysfunction was present in 41 out of 50 patients (82%). Among 22 patients with PH, it was present in 20 (90.9%). Among 28 patients without PH, it was present in 21 (75%). Prevalence of LV diastolic dysfunction was significantly higher among the patients with PH, compared to those without PH. RV dysfunction was present in 1(3.6%) and in 10 (45.5%) in patients without PH and in patients with PH respectively. Significant difference was found with RV dysfunction more prominent in patients with PH than in patients without PH (p<0.001). 64%of the patients studied had CKD of less than 6 months including 24%of new cases. 16%of the patients had CKD between 6 months and 1year. 20% had CKD of more than 1yr. In relation to PH, out of the 12 new cases of CKD,7 (31.8%) had PH and 5(17.9%)were without PH. Of the 20 patients having history of CKD less than 6 months (excluding new cases), 7 (31.8%) had PH and 13 (46.4%) were without PH. Out of the 8 patients  of CKD between 6 months and 1 year,4(18.2%) had PH and  4(14.3%)were without PH. In patients having CKD of more than 1 year, 4 (18.2%) had PH and 6 (21.4%) were without PH.
Conclusion: The study showed that PH is common in patients with CKD. Left Ventricular systolic and diastolic dysfunctions are strongly related to the outcome of these patients. Unexplained dyspnoea in patients with CKD must be evaluated for PHPulmonary Hypertension, CKD, Chest X-Ray, Left Ventricle, Mortality, ECG, 2D-Echo

Background
Chronic Kidney Disease (CKD) is recognized as a major medical problem
worldwide. Electrocardiogram (ECG) remains an essential tool despite the development of
modern technologies, for evaluation of cardiovascular disease.
Aim
To study the electrocardiographic findings along with the associations with the laboratory
variables and prevalence of cardiac arrhythmias in patients of chronic kidney disease
undergoing haemodialysis.
Method
The study was conducted on 100 in-patients who were undergoing Haemodialysis in G.R.
Medical College, Gwalior. A standard 12 lead ECG was obtained just before and after the
haemodialysis procedure. The electrocardiograms was reviewed on descriptive reports of
variables: Rhythm, Heart rate , P wave abnormalities, LVH, QT interval/ QTc, ST segment
changes. Patient was placed on the Holter monitor for 24 hours just an hour before the
dialysis.
Result
In the study subjects , there were 51% of them who had serum creatinine of (5.1-10mg/dL)
and 2% had serum creatinine of ( > 20 mg/dL). There were 37% of the study subjects who
were Smoking and 27% of them were Alcoholics, 81% were Hypertensives , 19% were
having Diabetes Mellitus and 14 % were Obese. It was observed that 5% of the subjects
showed Atrial Fibrillation on ECG after Dialysis and 95% of them showed a Sinus
Rhythm. Changes in the ST segment and Tall T wave on ECG were observed in 25% and
35% of the study subjects. Supraventricular Ectopic findings were observed in 19% before
dialysis and 48% during dialysis and 15% after dialysis respectively. On ECHO, 60% of
subjects showed Left Ventricle Hypertrophy and 28% had Diastolic dysfunction.

Introduction: Awareness with recall (AWR), originally coined as intra-operative awareness, is a recognized risk of general anesthesia (GA). Based on individual factors, patients respond differently to GA. The safety of GA has increased drastically over the past 20 years; however, there is continued opportunity for assessment, evaluation and treatment of AWR. Gibbs, Gibbs and Lennox (1937) first identified AWR in 1937.
Materials and Methods: The Present study was conducted at the Department of Anaesthesiology and Critical Care, Tertiary care center, Guwahati, Assam. Which includes 50 patients who underwent different routine general surgeries and 50 patients from Emergency. Pre-anaesthetic evaluation was done and noted down. In the operating room IV line established, multichannel monitor attached and standard monitoring including baseline pulse, NIBP, SPO2 and ECG connected. Entropy and NM monitoring equipment was attached. The choice of inducing agent, neuromuscular blocker and maintenance for general anaesthesia was based on the patient and nature of surgical procedure.
Results: These 200 patients were interviewed as per the protocol in hospital on the day of surgery. Our study found that among these 200 patients, 2 patients reported remembering something between going to sleep and waking up from anaesthesia, thus 2 cases of awareness were identified. 7 patients reported dreaming and 6 cases of possible awareness were identified.
Conclusion: Awareness occurs despite the usual clinical monitoring of anaesthetic depth like BP, HR and even with the use of entropy. There is currently no evidence that awareness and recall could be prevented by monitoring consciousness with sophisticated methods such as BIS or entropy. If a patient has suffered from awareness and recalls this postoperatively, psychiatric consultation and followup is recommended

Background: An excess burden of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is an established paradigm. The present study was conducted to assess the prevalence of acute myocardial infarction in patients with rheumatoid arthritis.
Materials & Methods: From the outpatient department, 150 patients with a confirmed diagnosis of RA were included in this study. Demographic factors including age, past and family history of MI were noted using a self-structured questionnaire.  MI was diagnosed based on symptoms, cardiac enzyme, and ECG. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) (IBM Corporation, Armonk, New York, USA). p-value of < 0.05 was considered significant.
Results: In the present study, 150 patients with a confirmed diagnosis of RA were included in which 53.33% were females and 46.66% were males. The mean age of patients was 48 years. 4.66% patients had previous history of MI and 6% patients had family history of MI. 14% RA patients had non-fatal MI and 4% RA patients had fatal MI. In 82% RA patients MI was absent.
Conclusion: The present study concluded that 14% RA patients had non-fatal MI and 4% RA patients had fatal MI.

Background:Snake bite is an occupational hazard for farmers and farm laborers in the Indian
subcontinent. Every year approximately 15,000 people reportedly died due to snake venom
interaction in India alone. However, unreported deaths are estimated to be many times greater
than the reported cases in the subcontinent.
Materials & Methods:ThisCross Sectional Observational Study was carried on sample size of
75 patients of snake bite admitted in Ward/ICU, Department Of Medicine, NSCB Medical
College, and Jabalpur on patients of snake bite reporting from all over mahakaushal area of
central India from March 2017 to August 2018.
Results: CPK-MB analysis shown to have highest raised values in neurotoxic group that is
32.3±0.9 IU/L which was higher in cases where local signs were prominent, 34.0±1.1 IU/L and
in cases without local signs it was lower 30.7±1.6 IU/L. CPK-MB values were for vasculotoxic
bites was also raised 27.3±1.2 IU/L, while for non-poisonous snake bites it was below upper
limit, 21±2.1 IU/L. A total of 39.2% (n=33) patients shown to have positive ECG findings while
rest 60.7% (n=51) shown no abnormality in electrocardiogram. Analysis of 2D-ECHO findings
was done for pattern of positive findings and found that most common positive finding was
pericardial effusion with 9 (10.71%) patients followed by 6 (7.1%) patients showed diastolic
dysfunction, and 5 (5.9%) patients each shown to have systolic dysfunction and RWMA.
Conclusion: CPK-MBanalysis shown to have highest raised values in neurotoxic group which
was higher in cases where local signs were prominent, and in cases without local signs it was
lower. Abnormal ECG was significant predictor of mortality in vasculotoxic snake bites.
Echocardiography was a significant predictor of mortality in neurotoxic bites.

The prevalence of cardiac autonomic neuropathy (CAN) in type 2 DM patients increases with
the duration and poor glycemic control. Patients with CAN are at increased risk for
autonomic dysfunction like resting tachycardia,abnormal systolic and diastolic function
leading to syncope and dizziness, prolonged QT interval, silent ischemia/infarction, lethal
arrhythmias and sudden death.Usage of 5 simple and cheap bed side tests for autonomic
function and corrected QT interval from ECG are helpful in early diagnosis of CAN. Early
recognition of CAN is helpful in delaying effects of CAN by strict control of blood sugar and
following healthy life style. Our study was conducted on100known and newly diagnosedType
2 Diabetes Mellitus patients<60 years whopresentedto Medicine OPD and admitted in IPD
wardsin Maharani LaxmiBai Medical College.Out of total 100 patients,49% had normal
score(0,1); 25% had borderline score(2,3,4); rest 26% had abnormal score ≥5; the prevalence
of CAN was 51%.Among 100 patients 47% patients were foundwith poor glycemic control
(HbA1C ≥ 8),in these 17% had early and 21% had definite CAN. Out of 100 patients of the
study, 55% patients had QTc>440ms out of which 17% had early and 23% had definite CAN.
The CAN also increased with older age group. So it is important to diagnose CAN early in
asymptomatic diabetics. There is significant correlation between CAN and QT prolongation.
QT interval in ECG can be used to diagnose CAN with reasonable sensitivity and specificity.
Usage of 5 bedside autonomic function tests are very helpful in early diagnosis of CAN.Strict
control of blood sugar can delay the early development of CAN. Intensive control of blood
sugar can delay the early development of CAN.

Non-invasive cardiac examination in standard clinic is still using 12-lead electrocardiograph. The results of the examination are presented on ECG paper or on the monitor screen. A normal electrocardiogram on one lead is not necessarily normal for the other lead, because each lead represents a certain part of the heart so that one by one is necessary. This examination takes time so that it can increase the stage of the disease if the patient turns out to be in an abnormal condition. This paper aims to correlate the peak amplitude of each lead to normal and abnormal heart conditions. If it is known that the peak amplitude is correlated between the leads, the other leads do not need to be checked, so that the diagnosis time will be obtained faster. Cardiac biosignal data that has been sampled with a frequency of 250 Hz is a discrete signal that can be stored digitally in a database. 10 samples of normal conditions and 10 samples of abnormal conditions were analyzed using Saphiro-Wilk so that the data were normally distributed. Spearman correlation analysis is used to get peak amplitude correlation between leads. The results showed that for abnormal conditions with a significance of 0.01 there was a correlation between the peak P lead I with leads III and V5, while for normal conditions there was a correlation between peak P lead I and leads V3 and V4. In abnormal conditions there is a correlation between peak R lead II and V6, while in normal conditions there is a correlation between peak R lead I and aVF.

Background: Hyperthyroidism is defined as excess concentration of thyroid hormones
in the body due to either increased synthesis of the thyroid hormone, increased release
of preformed thyroid hormones, or from endogenous or exogenous extrathyroidal
sources. The present study was conducted to assess cardiovascular manifestations of
hyperthyroid disorder patients.
Materials & Methods: 104 patients of hyperthyroidism of both gendersunderwent
clinical evaluation, basic laboratory tests like CBC, RFT, LFT and ECG and 2D ECHO
were performed in these patients to evaluate the presence of any cardiac manifestations.
Results: There were 34 males and 70 females. Age group upto 40 years had 20, 41-60
years had 34 and >61 years had 50 patients. Common symptoms were pallor in 90,
edema in 86, moist skin in 74 and eye signs in 53. Cardiovascular symptoms recorded
were chest pain in 82, palpitations in 95 and breathlessness in 60. Among 104 patients,
ECG changes were seen in 42 patients. Out of this, sinus tachycardia was seen in 65%,
AF in 10%, ST T changes in 6%, RVH in 7%, LVH in 11% and RBBB in 5%. The
difference was significant (P< 0.05).
Conclusion: Cardiovascular manifestations are quite common in hyperthyroid patients.

The Electro Cardio Gram (ECG) is a parametric index to diagnose heart diseases. During the process of acquisition of the ECG signals, it is added up by large amount of noise, which affects the patient diagnosis with respect to telemedicine. The noisy ECG signals have drift in baseline, motion electrodes artefacts, interference of line, muscle contraction noise, etc. Noise reduction is accomplished by making using of adaptive filter which employs wavelet transform. Computer simulation results are shown for the improvement in performance. This methodology adapted successfully removes various types of noise with Signal to noise ratio (SNR). The impact of noise and removal of it are shown in the waveforms and the methodology adopted has produced 82% improvement on the SNR of de-noised signals.

Background: Microalbuminuria has been recently found to be a marker of
atherogenesis. It is associated with various risk factors of atherogenesis and damage of the
vascular endothelium. There have been few studies in which it has been found that
mortality in cardiovascular disease are increased with microalbuminuria. Urine is
collected over 24 hours and this study has similar sensitivity as urinary albumin creatinine
ratio. A urinary albumin to creatinine ratio is as sensitive as a 24 hours urine study even
though it itself is a gold standard test. In patients with CAD other factors have been
explored then urinary albumin has been recently identified.
Objectives: To assess correlation between urinary albumin creatinine ratio with coronary
artery disease and to correlate Urinary albumin creatinine ratio (UACR) with
Framingham heart study Cardiovascular disease (FHS-CVD) score in all patients of
coronary artery disease.
Methodology: In this study which is cross sectional, Subjects to be included in the study
will be explained regarding the study and proper consent will be obtained. A random urine
sample will be collected. Urinary albumin concentration will be measured by auto analyser
and urine albumin creatinine ratio will be calculated. The values of the same will be
recorded and will be statistically analysed.